Download or read book Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care ACT ACA written by Suzanne M. Kirchhoff and published by CreateSpace. This book was released on 2015-06-26 with total page 32 pages. Available in PDF, EPUB and Kindle. Book excerpt: The 2010 Patient Protection and Affordable Care Act (ACA, P.L. 111-148) requires certain health insurers to provide consumer rebates if they do not meet a set financial target known as a medical loss ratio (MLR). At its most basic, a MLR measures the share of health care premium dollars spent on medical benefits, as opposed to company expenses such as overhead or profits. For example, if an insurer collects $100,000 in premiums and spends $85,000 on medical care, the MLR is 85%. In general, the higher the MLR, the more value a policyholder receives for his or her premium dollar. The ACA requires an annual, minimum 80% MLR for individual and small group insurance plans, and an annual, minimum 85% MLR for large group plans. Congress imposed the MLR to provide "greater transparency and accountability around the expenditures made by health insurers and to help bring down the cost of health care."

Download or read book Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act ACA Issues for Congress written by Suzanne M. Kirchhoff and published by Createspace Independent Pub. This book was released on 2012-10-20 with total page 32 pages. Available in PDF, EPUB and Kindle. Book excerpt: The 2010 Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) requires certain health insurers to provide rebates to their customers for each year that the insurers do not meet a set financial target called a medical loss ratio (MLR). At its most basic, a MLR measures the share of a health care premium dollar spent on medical benefits, as opposed to company expenses such as overhead or profits. For example, if total premiums collected are $100,000, and $85,000 is spent on medical care, the MLR would be 85%. The ACA sets the minimum required MLR at 80% for the individual and small group markets and at 85% for the large group market. In general, the higher the MLR, the more value a policyholder receives for his or her premium payment. Congress imposed the MLR in an effort to provide “greater transparency and accountability around the expenditures made by health insurers and to help bring down the cost of health care.” Insurers that fail to meet these minimum standards must provide rebates to policyholders. The Department of Health and Human Services (HHS), with input from state insurance commissioners who are the main regulators of health insurance, issued rules for implementing the provisions. These rules provided greater details for calculating the MLR and issuing rebate payments. ACA allows companies to include quality improvements along with medical benefits when calculating the MLR. In addition, state and local taxes and some licensing fees are subtracted (i.e., disregarded) from expenses in the MLR formula. ACA's requirements are different from those imposed by state laws, which generally compare only medical claims to premiums. Though a number of states have their own MLRs, the ACA is now the minimum standard that must be met nationwide by certain health insurers. About 12.8 million U.S. consumers were due more than $1.1 billion in ACA MLR rebate payments in August 2012, for an average award of $151 per qualifying household. Employers or insurers can provide the rebates, which are based on activity in 2011, via a check, an electronic deposit in a bank account, a reduction in future insurance premiums in the amount of the rebate, or by spending the funds for the benefit of employees. About 66.7 million people were insured by covered companies that met or exceeded MLR standards for 2011, and will not receive rebates. The MLR is based on the aggregate performance of a health plan, not individual policy history. Even if a beneficiary had no medical claims during a given year, he or she would not receive a rebate if the broader plan met the MLR requirements. In addition, many Americans were enrolled in health plans that were not covered by the ACA MLR provisions in 2011. The ACA MLR provisions cover only fully funded health plans, which are plans where insurance companies assume the full risk for medical expenses incurred. The requirements do not extend to self-funded plans, which are health care plans offered by businesses in which the employer assumes the risk for, and pays for, medical care. Non-profit insurers and some Medicare Advantage plans were not covered by the ACA MLR standards in 2012, though the MLR provisions will be phased in during 2013 and 2014, respectively. In addition, some states won special exceptions for individual insurance policies, based on a HHS determination that meeting the MLR requirement would harm a state's insurance market. Several issues have been raised about the MLR provisions since the ACA was enacted. These include considerations regarding the treatment of insurance agent and broker bonuses and commissions, the impact of the MLR on insurers that provide high deductible plans, and special rules for non-profit health insurers.

Download or read book Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act Aca written by Congressional Research Service and published by CreateSpace. This book was released on 2015-01-29 with total page 30 pages. Available in PDF, EPUB and Kindle. Book excerpt: The 2010 Patient Protection and Affordable Care Act (ACA, P.L. 111-148) requires certain health insurers to provide consumer rebates if they do not meet a set financial target known as a medical loss ratio (MLR). At its most basic, a MLR measures the share of health care premium dollars spent on medical benefits, as opposed to company expenses such as overhead or profits. For example, if an insurer collects $100,000 in premiums and spends $85,000 on medical care, the MLR is 85%. In general, the higher the MLR, the more value a policyholder receives for his or her premium dollar. The ACA requires an annual, minimum 80% MLR for individual and small group insurance plans, and an annual, minimum 85% MLR for large group plans. Congress imposed the MLR to provide “greater transparency and accountability around the expenditures made by health insurers and to help bring down the cost of health care.” The Department of Health and Human Services (HHS) issued rules to implement the MLR with input from state insurance commissioners, who are the main regulators of health insurance. The ACA statute and regulations allow companies to include both quality improvements and medical services when calculating total MLR medical spending. Insurers may subtract (i.e., disregard) state and local taxes and some licensing fees from total MLR expenses. The federal ACA requirements differ from many state MLR laws, which generally compare medical claims to premiums. The ACA MLR is now the national minimum standard that must be met by covered health insurers. The ACA MLR is based on an insurer's annual aggregate performance, not on each individual's policy history. A consumer who paid health insurance premiums but did not file any medical claims during a plan year would not qualify for a rebate if his or her insurer met minimum MLR requirements. In addition, many Americans are enrolled in health plans that are not covered by the ACA MLR. The MLR provisions apply to fully funded health plans, which are plans where insurance companies assume full risk for incurred medical expenses. The MLR does not extend to self-funded plans, which are health care plans offered by businesses where the employer assumes the risk for, and pays for, medical care. Medicare plans were not subject to the MLR during the first two years the ACA was in effect. These insurers began complying with MLR provisions beginning in calendar 2014. The HHS granted three-year MLR waivers to select states where it determined that MLR implementation could harm the individual insurance market. Congress included language in the Consolidated and Further Continuing Appropriations Act of 2015 (H.R. 83, P.L. 113-235) exempting expatriate insurance plans from MLR reporting requirements. For the 2013 plan year, insurers owed $332 million in MLR rebate payments to 6.8 million consumers. That is significantly less than the $1.1 billion in rebates to 12.8 million individuals in 2011, the first year the MLR was in effect. Insurers and employers may provide the rebates via a check, an electronic deposit in a bank account, a reduction in insurance premiums, or by spending the funds for the benefit of employees. Lawmakers have raised some concerns about the MLR provisions, including the fact that insurers are not allowed to deduct insurance agent and broker bonuses and commissions from their MLR expenses.

Download or read book Delivering Better Health Care Value to Consumers written by United States. Congress. Senate. Committee on Commerce, Science, and Transportation and published by . This book was released on 2014 with total page 76 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Affordable Care Act written by Sean R. Abernathy and published by Nova Science Publishers. This book was released on 2014 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Congress is deeply divided over implementation of the Patient Protection and Affordable Care Act (ACA). Since the ACA's enactment, lawmakers opposed to specific provisions in the ACA, or to the entire law, have debated implementation of the law on numerous occasions and considered multiple bills to repeal, defund, delay, or otherwise amend the law. Topics discussed in this compilation include the legislative actions to repeal, defund, or delay the Affordable Care Act; health insurance exchanges under the patient protection and ACA; health insurance premium credits in the patient protection and ACA; physician supply; annual fees on health insurers; and medical loss ratio requirements under the patient protection and ACA.

Download or read book The Affordable Care Act written by Sean R. Abernathy and published by . This book was released on 2014 with total page 213 pages. Available in PDF, EPUB and Kindle. Book excerpt: Congress is deeply divided over implementation of the Patient Protection and Affordable Care Act (ACA). Since the ACA's enactment, lawmakers opposed to specific provisions in the ACA, or to the entire law, have debated implementation of the law on numerous occasions and considered multiple bills to repeal, defund, delay, or otherwise amend the law. Topics discussed in this compilation include the legislative actions to repeal, defund, or delay the Affordable Care Act; health insurance exchanges under the patient protection and ACA; health insurance premium credits in the patient protection and ACA; physician supply; annual fees on health insurers; and medial loss ratio requirements under the patient protection and ACA. (Imprint: Nova)

Download or read book Crs Report for Congress written by Congressional Research Service: The Libr and published by BiblioGov. This book was released on 2013-11 with total page 46 pages. Available in PDF, EPUB and Kindle. Book excerpt: As part of the Patient Protection and Affordable Care Act (ACA), P.L. 111-148, as amended, Congress enacted a "minimum coverage provision," which compels certain individuals to have a minimum level of health insurance (i.e., an "individual mandate"). Individuals who fail to do so may be subject to a monetary penalty, administered through the tax code. Congress has never compelled individuals to buy health insurance, and there has been significant controversy and debate over whether the requirement is within the scope of Congress's legislative powers. Shortly after ACA was enacted, several lawsuits were filed that challenge the individual mandate on constitutional grounds. While some of these cases have been dismissed for procedural reasons, others have moved forward. These challenges have now reached the Supreme Court. During the last week of March, the Court heard arguments in HHS v. Florida, a case in which attorneys general and governors in 26 states as well as others brought an action against the Administration, seeking to invalidate the individual mandate and other provisions of ACA. Besides evaluating the constitutionality of the individual mandate, the Court is examining the question of whether the Anti-Injunction Act currently prevents the Court from ruling on the merits of the case. It also is considering the extent to which the minimum coverage provision can be severed from the remainder of ACA, if it is found to be unconstitutional. Finally, the Court is analyzing ACA's expansion of the Medicaid program and whether it unconstitutionally "coerces" states into compliance with federal requirements. This last issue will be addressed in CRS Report R42367, Federalism Challenge to Medicaid Expansion Under the Affordable Care Act: Florida v. Department of Health and Human Services, by Kenneth R. Thomas.

Download or read book Cutting the Red Tape written by United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health and published by . This book was released on 2012 with total page 144 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book The President s Health Care Law Does Not Equal Health Care Access written by United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health and published by . This book was released on 2015 with total page 128 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book The Impact of Medical Loss Ratio of Affordable Care Act written by Angela Keyu Lu and published by . This book was released on 2021 with total page 47 pages. Available in PDF, EPUB and Kindle. Book excerpt: In 2010, President Barack Obama enacted the Affordable Care Act (ACA) which significantly reformed the healthcare system. The Act obligated all people to have healthcare insurance or face a fine. Since medical insurances are expensive and commercial insurance companies are still the primary providers of medical insurance products in the market currently, it is a challenge to ensure that health insurance companies reduce premiums and decrease medical cost while providing quality service. Therefore, the literature review analyzed the content, influences, importance, and history of the medical loss ratio regulation so that audiences can understand the impact of the medical loss rate on medical insurance. The medical loss ratio (MLR) required that the insurance company spend 80%-85% of its premium on medical expenses, and any excess of the target percentage shall be rebated to policyholders. However, there is no need for the insurer to rebate if the amount is minimal. Also, through the Employer Health Benefits Survey analysis, it is concluded that the premium cost had increased every year from years of 2005 to 2020. Meanwhile, percentage change per year showed that although MLR has been implemented, the percentage change in 2011 decreased significantly compared with that in 2010. However, by the year 2013, the percentage change started to increase again, which showed that the medical loss ratio is still in effect, the rule still exists, but it has not been not effective in decreasing healthcare premiums. Moreover, before ACA-MLR was implemented, much of the premium was wasted because each state had different standards of the medical loss ratio. After ACA-MLR was implemented, many insurance companies were afraid to pay rebates due to this policy, and so they did their best to spend 80-85% of their premiums on medical expenses according to the requirement even when there was no obvious evidence that ACA- MLR could effectively reduce the premiums and cut the cost.

Download or read book PPACA s Effects on Maintaining Health Coverage and Jobs written by United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health and published by . This book was released on 2012 with total page 180 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Provisions in the Patient Protection and Affordable Care Act PPACA written by Benjamin J. Gray and published by Nova Science Publishers. This book was released on 2011 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: In March 2010, President Obama signed into law a comprehensive health reform bill, the Patient Protection and Affordable Care Act (PPACA), and a package of amendments to PPACA, as well as the Health Care and Education Reconciliation Act (HCERA). PPACA includes numerous provisions intended to increase the primary care and public health workforce, promote preventive services and strengthen quality measurement. This book on PPACA and HCERA focuses on the new law's workforce, public health, health care quality and related provisions. It includes summaries of these provisions, explores some of their implications for health policy and contains an associated timeline.

Download or read book The Affordable Care Act written by Tamara Thompson and published by Greenhaven Publishing LLC. This book was released on 2014-12-02 with total page 130 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Patient Protection and Affordable Care Act (ACA) was designed to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage, and reduce the costs of healthcare overall. Along with sweeping change came sweeping criticisms and issues. This book explores the pros and cons of the Affordable Care Act, and explains who benefits from the ACA. Readers will learn how the economy is affected by the ACA, and the impact of the ACA rollout.

Download or read book 111th United States Congress written by Wilma Quinn and published by . This book was released on 2012-05-08 with total page 136 pages. Available in PDF, EPUB and Kindle. Book excerpt: What's so special about Patient Protection And Affordable Care Act?In this new, compelling book from author Wilma Quinn, find out more about Patient Protection And Affordable Care Act ...The Patient Protection and Affordable Care Act, informally referred to as Obamacare, is a United States federal statute signed into law by President Barack Obama on March 23, 2010. The law is the principal health care reform legislation of the 111th United States Congress. PPACA requires individuals not covered by employer- or government-sponsored insurance plans to maintain minimal essential health insurance coverage or pay a penalty unless exempted for religious beliefs or financial hardship, a provision commonly referred to as the "individual mandate". The Act also reforms certain aspects of the private health insurance industry and public health insurance programs, increases insurance coverage of pre-existing conditions, expands access to insurance to 30??million Americans, and increases projected national medical spending while lowering projected Medicare spending.PPACA passed the Senate on December 24, 2009, by a vote of 60???39 with all Democrats and two Independents voting for, and all Republicans voting against. It passed the House of Representatives on March 21, 2010, by a vote of 219???212, with 34 Democrats and all 178 Republicans voting against the bill.A majority of the states, and numerous organizations and individual persons, have filed actions in federal court challenging the constitutionality of some or all of the elements of PPACA. As of January 2012, two of four federal appellate courts have upheld it; a third declared the individual mandate unconstitutional, while a fourth ruled the federal Anti-Injunction Act prevents the issue from being decided until taxpayers begin paying penalties in 2015. The Supreme Court heard six hours of oral argument on March 26???28, 2012, and is expected to issue its decision by the end of June.So, what seperates this book from the rest?A comprehensive narrative of Patient Protection And Affordable Care Act, this book gives a full understanding of the subject.A brief guide of subject areas covered in "111th United States Congress - Patient Protection And Affordable Care Act" include -- Patient Protection and Affordable Care Act- Health care reform in the United States- Health care reform debate in the United States- Health care reforms proposed during the Obama administration- United States public debt- Contraceptive mandates- Florida v. United States Department of Health and Human Services- Virginia v. Sebelius- Patient Protection and Affordable Care Act CasesFind out more of this subject, it's intricacies and it's nuances. Discover more about it's importance. Develop a level of understanding required to comprehend this fascinating concept.Author Wilma Quinn has worked hard researching and compiling this fundamental work, and is proud to bring you "111th United States Congress - Patient Protection And Affordable Care Act" ...Read this book today ...

Download or read book The Future of Nursing 2020 2030 written by National Academies of Sciences Engineering and Medicine and published by . This book was released on 2021-09-30 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The decade ahead will test the nation's nearly 4 million nurses in new and complex ways. Nurses live and work at the intersection of health, education, and communities. Nurses work in a wide array of settings and practice at a range of professional levels. They are often the first and most frequent line of contact with people of all backgrounds and experiences seeking care and they represent the largest of the health care professions. A nation cannot fully thrive until everyone - no matter who they are, where they live, or how much money they make - can live their healthiest possible life, and helping people live their healthiest life is and has always been the essential role of nurses. Nurses have a critical role to play in achieving the goal of health equity, but they need robust education, supportive work environments, and autonomy. Accordingly, at the request of the Robert Wood Johnson Foundation, on behalf of the National Academy of Medicine, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine conducted a study aimed at envisioning and charting a path forward for the nursing profession to help reduce inequities in people's ability to achieve their full health potential. The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise. By leveraging these attributes, nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity explores how nurses can work to reduce health disparities and promote equity, while keeping costs at bay, utilizing technology, and maintaining patient and family-focused care into 2030. This work builds on the foundation set out by The Future of Nursing: Leading Change, Advancing Health (2011) report.

Download or read book Upcoming Rules Pursuant to the Patient Protection and Affordable Care Act written by and published by . This book was released on 2013 with total page 29 pages. Available in PDF, EPUB and Kindle. Book excerpt: Federal regulations generally result from an act of Congress and are one significant means by which statutes are implemented and specific requirements are established. Congress delegates rulemaking authority to agencies for a variety of reasons, and in a variety of ways. The Patient Protection and Affordable Care Act (ACA, as ame nded) is a particularly noteworthy example of congressional delegation of rulemaking authority to federal agencies. ACA is a comprehensive overhaul of the health care system that includes such provisions as the expansion of eligibility for Medicaid, amendments to Medicare that are intended to reduce its growth, an individual mandate for the purchase of health insurance, and the establishment of insurance exchanges through which individuals and families can receive federal subsidies to help them purchase insurance. A previous CRS report identified more than 40 provisions in ACA that explicitly require or permit the issuance of rules to implement the law.

Download or read book US Healthcare Sector Organization Management and Payment Systems Handbook Volume 1 Strategic Information Developments Reforms written by IBP, Inc. and published by Lulu.com. This book was released on 2015-09-30 with total page 278 pages. Available in PDF, EPUB and Kindle. Book excerpt: United States Healthcare Sector Organization, Management and Payment Systems Handbook - Strategic Information, Programs and Regulations